| NPI | 1962768879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 16751) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R871673) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2013-04-10 |